Gonadal dysfunction and changes in sex hormones in postnecrotic cirrhotic men: a matched study with alcoholic cirrhotic men.

To investigate the gonadal dysfunction and changes in sex hormones in male patients with postnecrotic cirrhosis, and to compare them with those in alcoholic cirrhotic men, three age-matched groups of men (hepatitis B virus-related postnecrotic cirrhosis 27, alcoholic cirrhosis 21, normal controls 30) were studied. Twelve of the 21 (57%) alcoholic cirrhotics and 16 of the 27 (59%) postnecrotic cirrhotics had a history of impotence. Both alcoholic and postnecrotic cirrhotic patients had significantly lower basal testosterone, but higher estradiol and prolactin levels than the control group (p less than 0.05). However, no differences were noted between the two cirrhotic groups. The degree of reduced testosterone and increased prolactin levels correlated with the severity of the cirrhosis. Despite the low testosterone concentration, basal levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) were not increased in the cirrhotic patients. All the three groups studied had normal FSH and LH responses to the stimulation of exogenous gonadotropin releasing hormone. On the basis of these results, we conclude that: (1) impotence and low testosterone level are not infrequent findings in men with hepatitis B virus-related postnecrotic cirrhosis, especially in those with decompensated liver function. (2) The liver disease per se is important for the development of male sexual dysfunction. (3) The derangement of hypothalamic-pituitary function may play a role in the sexual dysfunction and changes in sex hormones in male patients with cirrhosis.